I was at lunch, just sitting there talking to my friend, Mike. We were chatting about how our holidays went, and mine had some ups and downs. I’ve been obsessed with getting through my trip down the rabbit hole with the Montana Board of Medical Examiners.

Mike teared up. “The thing I love about you Mark is that you’ll see anybody, won’t you?” he said.

My eyes got wide and I replied, “Of course, what else would I do?”

Mike was referring to the 22 “narcotic refugees” that I began seeing last April. Their doctor’s office had been closed in a DEA raid and the doctor’s license was suspended indefinitely by the state board. In the intervening eight months, no charges have been filed against the doctor, but his patients have had to fend for themselves, obtaining treatment for their chronic pain issues.

Dr. Mark Ibsen

Many came to see me in Helena. It is often said that Montana is one small town with very long streets. Going a couple hundred miles to see another physician is not that big a stretch for me, but it is considered a red flag for possible drug seeking or diversion according to pharmacists in my area.

So when my friend Mike got teary eyed about my service to these so-called narcotic refugees, I found myself a little perplexed. Of course I would see whoever comes through my door, particularly if they’re suffering. I don’t care if they’re having acute pain or chronic pain, if they’re in withdrawal, or if they have been abandoned due to actions by their doctor, pharmacist, or a state or federal agency. It doesn’t matter to me.

This situation called for a response along the lines of the Good Samaritan. I wouldn’t drive by a car wreck with an unconscious fellow citizen lying on the ground. And I certainly wouldn’t fail to respond to a call for help from the cockpit on an airplane flight.

I am wired to respond with my skill set when a contribution is needed. Of course I was shocked and chagrined when I heard that the unintended consequences of an action against a fellow physician was the closure of his office, confiscation of his records, and abandonment of all his patients. I know that if I did that in the course of my daily medical practice I would lose my license. And rightfully so.

So my automatic response in seeing the first patient on April 14 was to “spring into action.”
I wasn’t necessarily thinking about the consequences to me or my license. I was thinking mostly about the consequences to the patient for being in withdrawal and acute pain. I was concerned about the betrayal this patient was suffering from. He couldn’t find his doctor and his doctor’s office had crime scene tape put up across the door. He didn’t know what to do.

Articles in the paper mentioned patients doing a “rapid wean” with the medications they had left, but no word about where any of these patients could go to find alternative care after having their primary caregiver taken from them.

Now I find myself under investigation by the Montana Board of Medical Examiners. The attorney for the board has requested that the DEA investigate me. Two agents came to my office to interrogate me about my practice. While I found this somewhat terrifying, I thought the answers I gave were appropriate and responsible. I told them in no uncertain terms that I don’t run a pain clinic. I operate an urgent care clinic.

I also told them that I’m also concerned about red flags. I even notified them that several groups of related people were coming to see me from that previous practice. This looked initially like a potential “family business.”

I assumed that informing the agencies about this would satisfy my obligation to make them aware that there might be some people who could be breaking the law. Of course it’s also plausible to me that each of these patients had a good reason to be on their high dose opiates. I considered it to be a secondary issue however, since I had access to a prescription drug database and could see that each of these patients had been on very high doses of opioids for a long period of time, obtaining them consistently from one provider.

Of course, their doctor’s records were unavailable as they had been confiscated. But I did not feel I needed medical records in order to treat a person who is in pain and withdrawal. I consider them to be in a metabolic and physiologic emergency. Just like I would treat anyone who was dehydrated or having a heart attack – I would not care about their previous records during the initial phase of evaluation.

After eight months, most of these patients have moved on. Several I tried to refer to pain clinics out of town, to no avail. There is no actual ongoing chronic pain clinic operating in my town.

Those out of town pain clinics require pill counts to be done randomly, and the patient must live within an hour of the medical center in order to do the pill count. Therefore they won’t take any referrals of pain patients who live outside the area.

They also won’t take any patient of the doctor whose office was closed. He is now a pariah. All of his patients are being discriminated against. No other physician is willing to see these patients. They are truly “narcotic refugees.”

Yes, this appalling behavior is occurring right here in America, the land of the free and home of the brave.

Oh, and the doctor whose office was closed? No charges have been filed against him so far. Meanwhile, I’m scrambling to save my license because I’ve been accused of over prescribing narcotics to these patients as I have weaned them off high doses.

During these last eight months I’ve learned a lot about chronic pain, high dose opiate use, and the aphorism “no good deed goes unpunished.”

While it seems like an obvious assumption that family members moving in a group to obtain opiates would likely be diverting drugs, that didn’t seem to fit this scenario. I ultimately found a DNA test for opiate sensitivity. The family members that I have tested have uniformly turned up positive for “rapid metabolizer” status, indicating a need for high dose opiates to relieve any pain at all.

Naturally, and somewhat obvious at this point, genetic abnormalities run in families!

While two of these 22 patients did alter prescriptions and are no longer obtaining prescriptions from me, it is not clear whether those alterations were done in order to divert drugs or a manifestation of pseudo-addictive behavior.

There has been a change. It’s a radical change. Our patients are no longer our patients. The patient-physician relationship is in jeopardy. Right now, fear is the operative modality.

I am finding more and more that pain truly is a freaking terrorist. And terrorism has people sometimes behaving at their best, and sometimes behaving at their worst.

As I read some of these responds’,,it AGAIN becomes painfully clear,,how IGNORANT,,those are who do not suffer from chronic physical pain,,lawyers,Doctors,,who have not suffer’d 1 day like we do,,,Quickly I will tell u why I have the education to speak on this topic,,At 28,a women,20 years ago,,I was suffering from extreme physical pain under my left breast,sound familier,,it should,look at Dick Trickle,,the physical pain would start there,and any movement would cause the pain to spider across my entire left side of my chest,,x-rays,echo’s,blood work showed notta,,soo they blamed me,,I was a ,”women” we all know women don’t handle pain,it was in my head,,,,it was the ekg machines,it was me touching the leads,,had to be,,no-one walks away from inverted T-waves,st Segment changes,,then,,I tried to wake-up 1 morning,fell to the floor in complete agony,I couldn’t move in any direction w/excruciating pain in my left chest,,I was ok,,,laying flat on the floor,,tired,,,,,By this time 5 years had past,,I lost 80 pounds,,I was 5’7 and 95 pound soaken wet,,Every time I ate,it started the pain,I turned the wrong way,I breathed the wrong way,the physical pain started,lost my job,couldn,’t work,but again,,all my fault,by these ,”educated Dr.s,,Soo,,my hubby,,takes the sheet off the bed,,backs up the suburbans,and we go down to my Drs,2.5 hours south,,get to the E,R,,x-rays shows a collapsed lung,god my hands are shaking just remember this,,they brought my lung back up,via chest tube and sent me home,but scheduled me for a m.r.i.,,,they put me thru a m.r.i.,,,they see something behind my heart,,in the spine,,They re-caliber their m.r.i.,,and there it was,,a tumor,,on my cord,,pressing my cord to the right,my backbone to the right ,my heart to the right,my lung,,Again,,they blame me,,,and make me take off my top,,go thru the m.r.i. toppless,,I meam come on,,these were educated men,they werent’ wrong about me,,I was just another ,”drug addicted,”though never receiveing 1 medicine to stop my pain in 5 years,,,I was women,,it was just ,”panic attacks,”,,it was the machines,,it was my fault for touching the leads,,it was ,”artifact,” the big one,,No wonder why that chest tube hurt sooooo much,,,but again they said nothing to me,sent me home,,,Well,,I decide I would have to stop this physical pain myself,,if that m.r.i. showed nothing,,,I decided after all this ,95 pounds,in agony every day,,I was going to end that physical pain myself w/ a 38,,,I literally sat by the phone,with the 38 in 1 hand, the phone in the other,,if my Dr,,called and told me again,,theres nothing wrong,,I had no choice,,I couldn’t breath,I couldn’t eat,I couldn’t be useful in life at all,,I might as well be dead,at least the PHYSICAL PAIN would be over,,,but he did call,and told me,,they found the problem,,a tumor in my spinal cord,pressing the cord,the backbone,the lung,the heart all to the right,,then they started making excuses for their mistakes saying ”see,,it was hard to see ,,it was right behind the heart muscle,blah,blah,blah,”..As any Dr. reading this knows there is only 1 way to get these tumors out,,,my back was broken 8 times,,my heart muscle was burnt 17 times,ie… Read more »

4 years ago

LouisVA

Jeremy said on January 24, 2015 at 4:45 pm:
“And now because I’m addicted to a medication they don’t want to treat my pain. Now how is this even remotely smart. You prescribe me a medication that you, I ,and everyone else not living under a rock knows is addictive. But when I become dependent I’m a liability so oh better get rid of him. You all make me sick!”

Jeremy, there is a big difference between addiction and dependence! Please see:

Is there a difference between physical dependence and addiction? Located at:

This is probably one of the most irritating articles I’ve ever read. This Dr. is helping people deal with their pain. I’ve had nothing but problems from most Dr. because I’m dependent on Rx medications to work, play with my children, and do pretty much anything that involves any physical activity. I’ve been branded an addict because guess what the medication IS addicting. And now because I’m addicted to a medication they don’t want to treat my pain. Now how is this even remotely smart. You prescribe me a medication that you, I ,and everyone else not living under a rock knows is addictive. But when I become dependent I’m a liability so oh better get rid of him. You all make me sick!

This is an interesting story. On the one hand we have a seemingly compassionate doctor treating “opioid refugees”; on the other hand, it’s difficult for me or any provider to know if they are treating a legitimate patient simply by running a PDPM report. Here’s the kicker – urine screens are gaining favor as standard of care. But, the only way to really know how much medication a patient has been taking, or at the very least, how much is in their blood, is to do a blood level (See predicted opioid levels at http://paindr.com/wp-content/uploads/2012/05/Opioid-Serum-Predictability-and-Metabolites.pdf). This is not considered standard of care, nor is it done routinely by most doctors or medical providers. In order to keep and maintain a safe environment by treating “opioid refugees”, I would advise to follow recognized opioid guidelines including an opioid agreement and routine, but random urine screens. Above and beyond that, it would be smart to have a consent for long-term opioid use, to document well that the patient was counseled on the risks/benefits of chronic use (regardless of their previous provider because the new provider can’t know exactly what happened previously without the chart, and serum opioid levels. Finally, if the majority or a large number of the patient panel using requires chronic opioid therapy, it would be wise to have a Pharm.D. on site that has expertise in pharmacotherapeutics, opioid monitoring, and pharmcogenetics – it’s just shameful that Pharm.D.’s are not yet recognized as “providers” and can’t bill third party payers for this service, as they could offer a significant advantage to the patient and medical care team. In a perfect world, an investigating agency such as the DEA should look at the bigger picture, especially if there is a void for these patients, and if this type of monitoring is not done, they should collaborate with the acused physician, FDA and AMA and set such standards and recommend that moving forward, Dr.Mark Ibsen incorporate such safety measures if they aren’t already in place. That would be a positive outcome for all,

4 years ago

LouisVA

Best of luck to you, Dr. Ibsen. I am a patient of Dr. Forest Tennant who has been mentioned in these comments. I’m on an ultra-high dose and always frightened that my meds will be taken from me. Thanks for DOING NO HARM!!!!

4 years ago

Sandy

With all due respect Ms Gardner by the very nature of your job as a criminal defense attorney you aren’t likely to see a standard non-abusing chronic pain patient.
[except, maybe for MJ crimes]

While a small % of actual patients in chronic pain can become addicted [not the same as dependant, many many drugs cause dependency] the majority of ‘addicts’ start out with opiates obtained on the street and then attempt to obtain them through a doctor. Now that no longer works, or does with much less frequency, many have moved on to heroin.

[that is not to say you haven’t had any clients who sold half their meds simply to continue their treatment as without insurance chronic pain treatment is a very costly affair. One medication costs 900$ for a single 28 day supply!]

We know that troops guarded the poppy crop in Afghanistan, too. Coincidence that as we leave that country the heroin starts pouring in at the same time?

Coincidence that the DEA goes after patients, doctors and pharmacists in the hope to kick those addicts out of the medical office where they can receive the best help via monitoring and put them onto the black-market? [ya that’s my more conspiratorial mind at work there…]

We also already know, beyond any conspiracy theories that the DEA has aided and abetted the Sinaloa Cartel! So have banks like Wachovia.

Same head of the DEA since 2002, too.

Another thing to consider, opiates besides heroin are also smuggled into the country. One example, in a documentary the ‘drug kingpin’ did not have a patient bottle but a wholesale bottle he was distributing.

That means it was smuggled or the chain of command on the medication broke down long before the doctor/patient level.

4 years ago

Sandy

First, Dr Ibsen, thank you for trying to care for those ‘narcotic refugees’ because whether or not the patients you saw were addicted or not is a moot point. As you know the best way to treat an addict is seeing them in a medical setting. Though I believe addicts/diversion patients are more rare; the majority were legitimate patients in pain. Second to the colleague who claimed that there were no risks associated with sudden withdrawal. That is completely false. There are a myriad of risks including heart-attack in women over 40. Not to mention the secondary risks of depression leading to suicide as patients then feel ‘all hope is lost’ – while I hate to make the comparison here, lets take a look at the deaths from overdose to those of negligent gun owners. We don’t take away *all guns* because many owners are negligent. Rather many of us in Florida who follow the issue are insisting upon better training. Ahh yes… training is also needed for the pain patient and the all medical staff who may come into contact with such patients. Why are patients dying? Well lately if one is on an opiate + any other medications and dies in their sleep these are often ruled as ‘multi-drug toxicity’ and that is that another person is added to the stat. I knew a woman who died on the fentanyl patch. It leaked on me in 05, clearly I survived but the hospital didn’t know that fentanyl is a synthetic opiate [training!]. Since have never felt they were safe and should be reserved for extreme cases. In her case it was the first medication in the opiate arsenal used after her traumatic injury. Despite my pleas for her to request another medication and discuss options with her doctor, she remained on it and passed away in her sleep. Ruled ‘multi-drug toxicity’ so we’ll never know for sure if the patch leaked on her. [My leak was during the time frame of the class action lawsuit, the leak was with the newer patches tho.] Another consideration is alcohol and I’m not talking about those who abuse it. My 12hr medication has a sticker on it that says ‘alcohol may intensify these effects’ well…sounds almost pleasant, right?! Rather, it should say ‘alcohol can be *LETHAL* with this medication’ – again, training. The doctor and the pharmacist must be able to communicate how dire mixing alcohol with an opiate [or any medication for that matter…] can be. What else can reduce deaths from opiates? The OD kit. When discussing this with my doctor [I get injections and they do help too. So while on the table for 30+ mins we discuss many things] he straight away said “But that can encourage people to abuse their medications and take more because they have a safety net” I said, “hang on there doc – does the diabetic gorge on chocolate cake because he has insulin? Does the peanut or bee allergy people take… Read more »

4 years ago

Kimberly

Dr. Ibsen and Ms. Gardner, I suffer from adhesive Arachnoiditis and I live in Central FL. We, Floridians, have a law for intractable pain patients but it doesn’t seem to matter as most doctors and lawyers have declared that no one needs high opioids.
Dr. Ibsen, the people of Montana should be very thankful for you, not trying to take your license. It is sooooo wrong. As you mentioned about genetic testing, I too am a fast metabolizer of opioids. I require around 800 mg morphine equivalent and that just allows me to keep my pain under control permitting me to lay down 23+ hours a day and take one walk of 0.25 miles in 25 min. Instead of a 4 min mile, I walk a125 min mile.
Doctors in FL at even the Mayo Clinic couldn’t help. I flew all over the country, lying down since I can’t sit, to try to get help. I had a surgery done in CO which helped some, but then the adhesive arachnoiditis (AA) kept the pain from coming down. If I had not of found a doctor who treats people with severe intractable pain and had a primary care physician in FL that knew me so well that he was willing to learn, and understand that there are diseases, besides cancer, that require high opioids. I have had pain since age 13. I had multiple back surgeries and I managed for 25 years with 2-6 Darvocet. That allowed me to lead a fairly normal life. I did an exercise that triggered AA and the pain became untouchable by FL doctor’s general standards and the lawyers that mostly make up our legislature. FL has a large fault in the national problem, but they have over corrected by ignoring the constituents of the State of Florida, by lumping the handful of doctors they allowed to operate as candy stores in with all doctors in the state. I was appalled that the State of Florida would rather people suffer, as does it appear the State of Montana, than treat people in intractable pain. Almost no doctors but pain medicine doctors will treat patients. These pain management mills are more interested in giving epidural steroid injections for $2000/ 15 min, that have been shown to cause AA in patients. Even PM doctors are afraid to prescribe high dose opioids even with the intractable pain laws. How much research has been done on mitragyna speciosa? Has it had the same amount of trials as opioids over the centuries? Does Ms. Gardner know I
Where in the body it is processed and how much it will work? I find that people who haven’t experienced 24/7 severe pain, waking up s reaming in pain have no understanding of how these States and more care more for pets and their pain than people and our pain. Shame on all trying to make pain patients suffer more!

Unfortunately, caring physicians such as Dr. Ibsen are being targeted, yet doctors who harm patients as a result of unnecessary spinal fusions or epidural steroid injections are not sanctioned. There is so much more to share with the unsuspecting public. Several patient advocates including myself attended an important hearing on Nov. 24, 2014 at the FDA headquarters in Silver Spring, Maryland regarding the dangers of Epidural Steroid Injections (ESIs) used for back pain. Supposedly only 9 million epidural steroid injections were given last year (however, the numbers increase exponentially every year). Patients do not understand the significant risks that come with these steroid injections if the drug is misplaced in the intrathecal space – especially the risk of Adhesive Arachnoiditis. Arachnoiditis is a sentence to live in hell for the remainder of your lifetime. Check out the dosages for arachnoiditis patients in this article by Dr. Forest Tennant, who is a leading expert on intractable pain: http://www.practicalpainmanagement.com/pain/spine/adhesive-arachnoiditis-part-2-case-reports Back pain continues to be a leading cause of disability in our country, and ESIs are obviously not solving this problem in the US – or in Montana. At best, steroid injections offer temporary benefit. At worst, they cause arachnoiditis and many other problems. Harmed patients are often misdiagnosed with Failed Back Surgery Syndrome, post-laminectomy syndrome, Fibromyalgia or Complex Regional Pain Syndrome. Imagine going in for an injection for back pain and coming out with a permanent intractable pain condition — and the need for opioids for the remainder of your lifetime, then having difficulty accessing this therapy because the wrong doctors are being targeted. Instead, the Feds and State Medical Boards should be going after interventional pain physicians who are not adequately informing their patients of the REAL risks of misplaced steroids in the spine. The dirty secret is that Pfizer wants Depo-Medrol banned for epidural use around the world, but interventional pain physicians are motivated by profit as they typically make around $800 to $1500 for a 10 minute procedure. Federal Work Comp is willing to pay top dollar approximately $2000 to $2500 per injection. Please check out these links: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642757/ http://cklaurence.com/epidurals.html We hope the Montana State Medical Board figures this one out as this story is breaking from the New York Times to the Missoulian: http://www.nytimes.com/2014/11/26/science/panel-decides-against-strongest-fda-warning-on-steroid-injections.html?_r=0 http://missoulian.com/lifestyles/hometowns/ravalli-county-residents-take-epidural-warning-to-fda/article_b45c9d85-c265-5f16-a6b2-31adeb21f053.html Arachnoiditis is a growing problem because physicians want to cover it up after they harm patients. Joel Burnette suffered terribly and ended up committing suicide: http://www.thenationaltriallawyers.org/2014/03/2-88m-med-mal-man-suicide-pain/ It is ridiculous to target physicians such as Dr. Ibsen. I personally think the Montana State Medical Board cannot see the Forest because of the Trees as all these issues are connected: 1. back pain is a leading cause of pain and disability, 2. epidural steroid injections are resulting in permanent harm, and 3. we have an untreated chronic pain problem in Montana. Epidural steroid injections are not reducing the need for spinal surgery because Montana cranks out a high rate of spinal surgeries when compared to other states (per capita). I have brought this issue up… Read more »

4 years ago

Mary Maston

Funny story – I had a complete hysterectomy on Jan 5. It was long overdue for a lot of reasons. My nurse in the hospital gave me a Valium that night to help me sleep, and it worked beautifully. I have never taken it before. She told me that I should ask the doctor for a prescription for when I went home so I could make sure I got enough rest. She said they were usually good about doing that. When he came to see me the next day, I told him the nurse mentioned it and how well it helped me sleep. He made a face, and said he wasn’t going to prescribe it because “it’s highly addictive.” Yes, because prescribing me 5-7 pills, one per night to get me through the first week of a major surgery, is going to turn me into an addict and have me selling myself on a street corner the following week so I can get my fix. Seriously!?! I let it go, and just considered myself lucky that he prescribed the lowest dosage of Percocet available to get me through. It was better than nothing. I wanted to educate him on addiction vs. dependence. I wanted to tell him how irrational his “logic” was, and school him on all the tidbits and actual facts I have learned about chronic pain, addiction, and the sheer stupidity of the government in all of this – since I have been a chronic pain patient for the last 7 years. If I was an addict, or had any intention of becoming one, it would have happened long before now. I am a walking kidney stone factory with 2 different rare kidney diseases. Believe me, I know all about pain. I live with it 24/7/365 and don’t take anything at all for it because of these new, stupid laws. I wanted to tell him that I understand his position – being a doctor in this drug war, and never knowing if the government is going to come knocking on his door because they think he’s prescribing too many pills to too many people. What I REALLY wanted to do was throw something at his head for the comment he made. This whole thing started out with good intentions. Go after the bad doctors and stop them from handing out pills like candy. I get that, and I admire the initial goal. Somehow though, it’s turned in to this government free for all – “We’re going to take them ALL down. If they prescribe pain medications, they’re on the radar” thing. What the government is really doing, is signing death certificates. Possibly millions of them. It just hasn’t come full circle yet. I honestly don’t know what it’s going to take. Personally, I’ve written letters to the FDA and state legislators. I know a lot of chronic pain patients that have as well. Hundreds, if not thousands have. There are blogs, websites, etc all over the internet not… Read more »

4 years ago

Robin Colucci

I just want to thank you for taking care of those patients in need. I have chronic pain from Sjogrens Syndrome, Fibromyalgia, and severe osteoarthritis (I am 42 with one knee replacement under my belt). I will never be cured, and will be on some kind of prescribed pain meds until the day I die. I cannot imagine being one of those patients that find themselves in a situation that they cannot get their pain meds. What you are doing is the right thing to do. You are lessening people’s suffering in many ways.Thanks for being the doctor and person that truly cares about his patients!!!

4 years ago

Susan Sheley

It is not right that the people who these drugs were originally created for are now having so many problems getting their prescriptions filled. Yet, there is a real problem in how to identify the abusers from the true patients. What will replace these medications when the government decides to end the problem by prohibiting them?

4 years ago

Mark Ibsen MD

I got this from a colleague today. He could not figure out how to post.

“Mark, I don’t see how I can comment on each of these posts individually. All I can do is remind anyone who will listen that the reason for state Medical Board’s concern is that people ARE DYING from overdoses of prescribed opioids, often combined with anxiolytics, and people ARE DYING from diverted drugs. On the other hand, people do NOT DIE from narcotic withdrawal, and the discomfort they undergo CAN be ameliorated by appropriate treatment. I DO see cases of drug diversion pretty routinely when reviewing disability cases, and not just diversion to a relative in need. I can’t see how you can defend Dr. XXX, because he DID kill at least 2 patients from overprescribing opioids, and learned nothing from that. He continued to prescribe massive numbers of pills to some patients, far more than anyone could actually take by themselves: over 3000 pills in 1 month, and 8000 in 3 months, and I believe that was a combination pill containing acetaminophen. You don’t think those were being diverted? PRIMUM NON NOCERE! And you couldn’t have learned much from his records if you had obtained them, because he didn’t bother to keep much in the way of records. I know, because we tried to obtain records from him for some of his “patients” (the 5-minute visits for a green card.)

If your records show that you made reasonable efforts to prevent drug diversion, and monitored your patients for IMPROVEMENT in functional level and absence of severe side effects (including heightened and disabling anxiety) then I think the Board will find in your favor. However, I was discouraged to read that you had NOT tapered off the opioids on all the patients that you told me you had. I haven’t read many of your Urgent Care Plus notes over the last few years, but my recollection is that your checkoff system was difficult to interpret. I hope your attorney has given the Board any clarifications that would help them to confirm whatever essential information IS in the records. I’m still pulling for you, but I don’t have access to any of the records that the Board must review, so I don’t know how optimistic to be.

Best of luck,”

4 years ago

Ann

Don’t stop. There is soooo much support for you and this cause.

4 years ago

Ray Norton

I’ve known Dr. Ibsen almost 7 years now. He is a man dedicated to what he believes in, helping those who are suffering with chronic pain. Thanks Mark for not backing down.

4 years ago

Kate

with due respect to all legitimate comments and having suffered chronic pain from 1) numerous car wrecks for which I was not at fault, and; 2) a condition that went undiagnosed for 6 years that was extremely painful and eventually robbed me of an active, successful life that I loved. All of the PT, Deep Tissue massage, TENS therapy and disc traction were temporary measures, often not covered by insurance and still did not afford me anything resembling normal. Until my very brave Rheumatologist had me attempt (with Benadryl) a low-dose opiate-that was 8 years ago. I have never requested an increase, as I am thankful for the relief I so desperately needed. Kudos to Dr Isben for following the Hippocratic Oath, as well as bearing the ‘witch hunt’ so well known to many. Including patients.

4 years ago

Ariela Marshall

Dr. Ibsen:

As a chronic Pain Patients for years, I applaud you for keeping true to your Hippocratic oath of “Doing No Harm” and of your belief that “The Healing Begins when you walk thru the door”. Your doors are open to everyone who seeks healing, You have this natural gift of “being with” the patients and hearing what matters and concerns them. You are a physician who treats not only the physical pain but also the emotional pain as well. You give your patients options, tools and strategies to deal with their pain. You do not reach for that Prescription Pad without first thinking of “what is the best Plan of Action” for that patient. You empower your patients to live the most productive and thriving lives they care in the face of their circumstances, Thank you for taking the “Pain” conversation public and being “the one” to keep that conversation alive. May you always stay true to your convictions and passion. Thanks for being willing to follow your convictions and travel down those unexplored, unchartered roads that many of your colleagues are not willing to taking.

Dr. Ibsen, I have chronic pain from two discs that have been herniated for nearly two decades. I have regulated that pain with marijuana for most of that time. The few times I was in sever pain, I would get prescribed a narcotic and sure enough, I would either do too much physically and aggravate my ailment even more or have to save up my pills for times I really needed them and they would expire. Nothing else works right. in july I strained my back and went to the emergency room. I explained my situation to the dr. and asked him to please give me something that would get rid of the pain. they gave me a cocktail of four different pills that first of all,scared the heck out of me, I do not do pills for personal reasons,but they were ineffective for the pain. A wasted visit. I even complained to the hospital refusing to pay for my service was not rendered. I was at a loss, I obtained my medical card the first year, after legislation decided that their hyped up fears trumped my pain and the majority of voters, I could not afford to obtain it again. Well, I am ashamed, but the only other drug that even came close to dumbing down the pain was the stuff not to be talked about. well hippa be damned if the door is open right? on Christmas day with pain so sever, the nurse I spoke with suggested I could have a problem with my appendix…so I went back to the e.r. being an honest person, plus the possibilities for something going wrong, I told them what I had been using for pain, she yelled it out the open door, what happened next may be a matter of public record soon. safe to say, in an emergency, besides urgent care, I will risk an hour to make it to benefis. the dr. that cared for me I believe was a good man. my point is, if I was able to afford my medical card, I would of been able to obtain the medicine I know works for me without the risk of street drugs or overmedicating where I would without fail make my back worse. I cant tell you how important this is. I have two children, and I love them more than anything. pain will drive a man to risk everything for that relief. its not right. thank you for standing up for me when I cant, literally. if you need any help for anything, errands, whatever, please let me know.

4 years ago

Suzanne

First, I don’t want lawyers, insurance companies, or politicians deciding my medical fate. That is what will happen if someone like Mark loses his license, as it will become against the law for doctors to make medical decisions concerning our health. So this decision is really about who will become the medical decision makers as this decision has the potential to create robot MDs. Along that same line, I live with a chronic illness where every lay person I meet instantly becomes a “medical professional” exclaiming that I must try the latest fad in order to feel better. Now that in itself is frustrating. I thank my lucky stars that is not my current reality since I don’t count on their expertise for healing. However, if someone like Mark loses his license then that will eventually become everyone’s reality because people without MDs will be making the decisions. That potential reality is the nightmare that we now face. Do we really need people who have as much medical training as the local school janitor making potential life or death medical decisions for patients they have never met? I sure don’t want that. When we are chatting with someone online, they claim that at least 60% of communication is lost since you cannot see the person face to face. So we are going to allow people who have never met patients to make medical decisions for them? Without meeting the person most communication is lost, does the medical board have statistics on how much health care is lost when a patient who they have never met and know nothing about has decisions made for them by lawyers, politicians, medical boards, pharmacies, and/or insurance companies? Without that data I’m afraid that taking away Mark’s license would be negligent. Second, here is a reality; people with chronic illnesses have extremely high suicide rates and that is with access to pain pills and proper medical treatments. This is a well known statistic. If the medical board is truly concerned about people’s welfare then they will worry about ALL people rather than claim their concern is only for addicts. Currently, society views addicts as the lowest ring on the ladder. When the media refers to addicts they use derogatory words such as “drugs” instead of “prescription medications,” which is highly manipulative and implies wrongdoing. Why are people with legitimate chronic pain getting thrown into the category of “drug” user? According to this article it isn’t the medical expert who did this, it is the lawyers, media, and politicians; the new medical decision makers. As a whole, society doesn’t care about drug addicts (unless you happened to own a drug treatment facility), so what this is really about is people vs. money. It is always about the money. All wars are fought over money and this is a war on the American public. So who is going to win? People or money? We, the people, are strong in numbers and we are watching this decision.

4 years ago

David Marshall

It seems to me that Dr. Ibsen is one of very few doctors who are concerned with patients who have “unusual” pain, and knows that “unusual” methods are required. But the state knows only the “usual” pain and the “usual” methods. The state has no answer to the question of what to do when the “usual” methods fail, other than to punish the doctor who tries the unusual. When someone does something “by the book” and the action fails, it is possible that the “book” is wrong? Please, you members of the Board, recognize that the unusual is becoming more usual, and embrace, rather than destory, your practitioners who are willing to deal with the unusual cases. If you don’t, you may soon find yourselves in a state in which the only medical care left will be hospital emergency rooms, and people who are suffering will be dying rather than recovering.

4 years ago

Claudia Burdick

It is so sad when compassion is criminialized. Do no harm is the physician’s oath, which is quickly becoming a joke. Many are choosing to abandon the doctor/patient relationship, preferring to “go it alone” rather then be tortured by the medical establishment. When there is one lone voice of compassion, people are naturally drawn to it in their desperation. In order to recapture the many, many patients the medical establishment has lost to alternative methods, please wake up and offer compassion and listening from your bag of tools. Dr. Mark Ibsen still has these tools of compassion and it’s so sad to see the powers that be attempting to wrench these from his competant hands all in the name of compliance. I am not in pain. I have not needed pain medications or narcotics, but I have seen first hand the value of compassionate help through the use of pain medications for those I love. Please understand the value of physicians who listen with compassion to the cry of the tortured. Dr. Ibsen is a good doctor. Please allow him to continue to help his community and those who suffer.

4 years ago

Kurt W.G. Matthies

I appreciate what Dr. Ibsen is doing, but I’m afraid he’s making himself a target in the war on pain.

I’m not sure that going at this one at a time is a strategically sound plan to turn back this new prohibition. We sure could use some kind of working committee comprised of interested practitioners, prescribers, patients ,and pharmacists — we all have an interest in preserving a doctor’s right to prescribe, a pharmacists right to dispense, and a patient’s right to privacy.

A mass movement of unified, concerned citizens that applies political force is the only thing that Washington and statehouse regulators will understand.

4 years ago

sandra l dubble

Dr.Ibsen…you may be our last hope. I so admire your courageous stance and pray that you are vindicated.Having chronic pain is like living in a wasteland with no oasis in site.

The War on Drugs has become a war on pain sufferers. We need people like you to fight for us.

I am so sorry for the toll is has and is taking on your life.

I have fibromyagia…over 20 years worsening as time passes. I also have 3 ruptured disks, spinal stenosis, facet joint problems and arthritis in other areas. My meds. are limited to 3 codeine tablets…30 mgs .a day and clonezapam….tried 3 muscle relaxers that do nothing.

This pain is intractable..I so wish that detractors could experience it …just for one day. Maybe they would understand what pain does to you..your life…those around you. Do they really understand the statistics ? I’ve read that suicide is the leading cause of death in those with fibro…I don’t know what it is in the entire chronic pain population.

My Primary Dr. is always so concerned about dependence…addiction. I want to tell him that I don’t really care.

Keep going Dr. Ibsen…we need a voice. I hesitate saying that , as the toll on you must be terrible.

From the bottom of my heart…thank you!

4 years ago

Kimmie K

Dr. Mark,

Keep kicking ass…the world needs ohhhh so many
More like you. You inspire.

Kim Koenigs

4 years ago

Mark Ibsen MD

Elizabeth Gardner: thank you for your post. I think you have been misunderstood. People are pretty touchy about the term addiction versus dependence, but what I hear is an attorney who is actually interested in the probable chronic pain and the consequences of the so-called or against pain. That’s the odd thing about people posting passionately: Sometimes our passion outstrips our listening.
Fortunately my compassion for attorneys has remarkably increased recently. Right now I have four of them. You know you’re living a powerful life when you have for attorneys I’m appreciative for everything each of my attorneys has done for me. I now understand why a term of respect is:
Counsellor.
Thank you for your contribution.

4 years ago

Valerie poris

You are an angel from heaven. You will be rewarded someday. My heart goes out to you for having to make tbese decisions. You are doing the right thing, never doubt yourself. The DEA is the devil in disguise.

4 years ago

Rachel

Dr. – Thank you for caring. Anyone who presumes all patients seeking something to take the physical pain away so that they can be NORMAL or at least able to function with tolerable pain are drug addicts has never experienced true unabating pain. They should be forced to undergo it first hand and only then should they be allowed to have an opinion. Torturing those who live with insurmountable physical pain because some physically well people choose to abuse these medications is terrorism – by the government. Dr – Your good works will not go unnoticed.

4 years ago

JONATHAN

ELIZABETH;;;
THE ONE WHO ARE ON OPIATES THAT START HERRION ARE THE ONE WHO ARE ABUSING AND NOT USE FOR THERE HEALTH WHICH WOULD BE TO RELIVE THEIR PAIN IF YOUR IN CHRONIC PAIN DAILY IT TAKES A TOIL ON YOU “MENTAL” “PHYSICAL” “EMOTION” AND OTHER HEALTH FACTORS

4 years ago

leah crow

I am a chronic pain suffer to and thank you so much dr lbsen for what you did and took a stand for all them people I go a hour to my pain management doctor hour there and back and I have fibro and arthritis in my neck my knees and my back and I think my hips and also have ddd in my neck and my hips and maybe my back and have bulgeing dice in my back and in my neck and I fell in sept 2014 and brused my right knee cap and also have a frachure in my knee cap but anyways my pain management doctor is helping me even thou I live a hour away and he cares and listens to me but again thank you so much for what you did and hope that it works out and they leave you alone

Ms. Gardner.. It would be more helpful if our judicial system and all those within it… refrain from practicing medicine and imposing more “moral crimes” on those within our society.. Our system used racism and bigotry and a “war on women” to create the Harrison Narcotic Act 1914 and the court determined that opiate addiction was a crime and not like all other addictions that medical science has determined are mental health diseases. At the same time they determined that physicians were not allowed to treat/maintain these criminals that were addicted to opiates. That act was the beginning of the black market for opiate & MJ products. We are now spending over 51 billion a year trying to rid our society of the black market that we created… for at least the last 100 yrs we have had between 1%-2% of the population abusing some substance other than alcohol & tobacco .. and we have spent over ONE TRILLION dollars since the start of the BNDD in 1970 trying to stop these mental health pts.. abt 6 million in total.. today we are spending over $9,000/yr/abuser trying to get them to stop. More than we spend per person for healthcare each year. IMO.. the various states’ Prescription Monitoring Program and NLPEx have so many loopholes in their system.. that they are a JOKE.. I have tried to talk to legislators and bureaucrats about using existing technology to improve the PMP… to date.. I might as well as talk to a brick wall… The only conclusion that I can come to is that all those withing the judicial from the cop on the street to DOJ are pretty happy with all the paychecks/jobs that that 51 billion dollars provides. Perhaps you should read stories like this http://www.news-press.com/story/news/crime/2014/09/08/death-investigation-at-groves-rv-park-in-fort-myers/15280035/http://www.rawstory.com/rs/2014/11/mich-medical-marijuana-card-holder-commits-suicide-after-police-witch-hunt-over-pot-butter/http://www.pharmaciststeve.com/?p=6936 There are 40 K suicides in this country each year.. how many of those because they can’t get adequate therapy for their chronic pain, anxiety, depression or other mental health issues… because of the interference of our judicial system with our healthcare system ?

4 years ago

brenda myers

I think letting people like me suffer is wrong on so many levels. Why should we be left to suffer when they have meds that can relieve it?? I have been told to learn how to “live with my pain” thats rediculous. We will have many suicides coming-maybe even mine-if this remains the way it is now. We need doctors to stand up to the DEA-if all pain doctors stood up we could get them to back off and let the doctor treat the patients as it should be.I am in severe pain all the time-its like torture-how they take war prisoners and make them squat to bring on pain-is how I live.

4 years ago

Kathryn Borgenicht, M.D.

I am continually saddened by how we have demonized peristent pain patients and how we have such limited resources to treat these clearly hurting patients. As you well know, opioids are just a part of the equation for treating persistent pain patients but we have such limited access to other modalities.
I so appreciate what you are doing and support your efforts

4 years ago

Coonhound

Dr Ibsen,
Thank you sir for having a pair. If more doctors would stand up for their rights and those of their patients, the DEA would be out of the examination room in no time. The organizations are there for this to occur. The invasive restrictions are already in place in the forms of state PDMPs, REMS, opiate contracts, pill counts, etc, etc. They are obviously working as addicts are turning to heroin as street supplies of Rx opiates dwindle. It is time to continue to let these measures work and leave legitimate patients and their good doctors alone. Like yourself I am extremely disturbed at how the disabled citizens are being treated in this ‘land of the free’. If these meds are there and we do not use them to treat pain from incurable disease states that are documented as causing pain who else are they for? Those like myself, who are disabled by incurable systemic autoimmune disease have enough symptoms and systems involved WITHOUT having to worry about pain, which when untreated (or under treated) just exacerbates everything else.

Elizabeth, please educate yourself before spouting off such destructive rhetoric. Legally addicted? I would think an attorney would know the difference between addiction and dependence if they were truly representing real patients. My guess is you are seeing the influx of the drug seekers who have no legal home now. They are now lining up for ‘treatment’ at my legit PM clinic (and from what the nurses tell me, being dismissed just as fast).
I mentioned the change in their clientele after observing their boisterous behavior and ‘interesting’ conversations in the waiting room, always leaving and speaking in hushed tones when receiving cell phone calls, etc. The last thing I want to do after a long day at the hospital and pharmacy is ‘hook up’ w/ my pals.

Harm to the body?Opiates are quite tame on the human body.[when taken as prescribed]. I dont recall the pharmacy instruction printouts suggesting taking several opiates at once or to mix them w/ your favorite adult beverage and xanax for ‘fun’. Personal responsibility is something that needs to re-enter the country’s vocabulary. Then ambulance chasers like yourself might need to find real jobs and quite trying to blame poor decisions, which result in ODs and addiction, on doctors and pharmaceutical companies.

Thank you for being courageous. I am currently diagnosed with Ehlers-Danlos Syndrome, though the N.I.H. believes I may actually have a painful connective tissue disorder yet to be identified. How did we pain patients become the pariahs of the medical system? Hounded by the DEA, shunned by pharmacies, abandoned by doctors (except ones like you). There was even a story this summer in my town about a cancer patient who could not get her narcotics because of the ridiculous shipment limits to pharmacies, who screamed and begged her husband to shoot her.

If insulin was being used to get high, would they stop diabetics from getting access to it? It shocks me that a medication which is legally prescribed, to a patient who has jumped through all the hoops and been responsible — cannot get it filled at a local pharmacy.

It is discrimination and a violation of human rights, according to Human Rights Watch. There was an article about is being a rights violation on this website back in 2012, search for article: “Is the War on Pain Patients a Human Rights Violation?” Leaving us to suffer through cold turkey withdrawal is a kind of torture, and for many of us with chronic illnesses this complicates the process and could cause us additional suffering or even death.

I don’t know if that will help any of us in this struggle, but I sure wish we could get some sanity brought to the issue. Where is the empathy for us?

4 years ago

Julie

Thank you, Dr. Ibsen for being willing to do what’s right for patients as opposed to running scared as so many doctors do. In regards to your remarks, Elizabeth Gardner, patients are turning to illegal drugs in South Florida because they can’t get their legally prescribed drugs. Either they can’t find a doctor to see them and prescribe pain medications or they have a legal prescription that a pharmacist refuses to fill. I imagine many of these people aren’t addicted to legal prescriptions as you put it but have built up a tolerance to them. As someone who lives in constant pain 24/7, my prescription medications allow me to have some semblance of a normal life. We as pain patients aren’t addicts, and quite frankly, I’m offended by your remarks.

4 years ago

Sherri

i want to thank you, as one of many chronically ill patients, for your bravery. I don’t think there are many doctors these days that would do what you’ve done, knowing the fear that has swept most of the doctors and patients because of this witch hunt. I am lucky, as I have a wonderful pain management doctor that I’ve been with for almost three years. I do travel one hour or so to see him each month, and didn’t realize this is a red flag ( of course it is, anymore one small issue is magnified by the fed govt. But I and countless others I know worry each time we go that we will have the same problems others have already encountered. And it is ridiculous that this happens. And there are places that don’t have this care at all. Chronic pain is genetic. My mother has polymialgia, my grandmother had Rhuematoid Arthritis, I have fibromyalgia and Psoriatic Rhuematoid Arthritis, and my sister has some for of chronic pain that has yet to be figured out. She has no one to turn to and it frustrates me. My mother thank heavens has a rheumatologist to prescribe her pain medication, but so far no luck for my sister and she suffers daily. And the suicide rates for people in pain that cannot find help is rising daily, but no one hears of this, only about the abuse of pain medications. We as a society are living longer and longer, and our bodies were not meant to do this, as with almost everything else that ages, it breaks down. When will all of this factor in for those in charge? I wish they could all live our life for one day. I can’t say a week as my pain I would not wish on my worst enemy. But one day, and no meds, and have them tell us ( chronic pain patients) we do not need pain medication. I feel as if I’m one of the lucky ones who can still enjoy some aspects of my old life, but they are becoming fewer each year. I also fear losing friends and family who aren’t as lucky as I as this witch hunt gets worse. They will have little choice left but to end their life rather than endure this pain, for almost every one of us have already been there, and probably already have the ending figured out. How many of us will it take to get this ended? Maybe you could help? I’m not sure what we have to do to make them understand, but if you’ve got ideas, maybe we can finally make a stand. If not, I truly thank you for all you’ve already done, because of you, there are a few less suicides, and less people in pain. For that you deserve recognition, not jail. I’m sorry this is so long, I did not intend that. But I hope I’ve touched on everything we with chronic… Read more »

4 years ago

Stephen S. Rodrigues, MD

I’m NOT shocked at what the Medical Boards and even the DEA are doing. They are blinded obedient souls doing their jobs. They are doing their jobs very well.

What shocks me the most is the venom and poison aimed at my part of this mission. I’ve been called stupid, hubristic, selfish, asinine etc. Just for acknowledging what I have discovered, witnessed and have practiced for 15 years.

Attacking my part of the mission undermines and slows the entire mission. Most if not all of you do not know this and the impact it is having by dividing us we are easier to conquer. It is working perfectly too. Every story, every article, every FB page have all figured out how to accomplish this mission and will not accept the experiences and wisdom of others who think differently. This is human nature at its worst.

Did you know that the AMA went on a campaign to squash, discourage, disavow and eliminate alternatives ie. Chiropractic Medicine? Did you know there are still vestiges of this “infection” slander campaign are still going on today.

The AMA advises our entire healthcare systems, the HHS, NIH, Medicare and the V.A.. So all of the policies and procedure are corrupted by this implanted seeded idea. Many advisors, physician, administrators carry the seed and do not even know that they are infected.

My nemesis who’s always is countering my posts with his distorted message is an example of how this infection is spread.

Gee, in actually it we ALL have the same mission which is to HELP = helping eliminate long-term pain.

What is hidden from your view and conceptions:
Long-term pain is invisible to technology so you can not medicate it or fix it away.
If you attempt to “fix it” you will fail.
If you attempt to medicate it you are half-stepping and you will fail.
Long-term pain will not go away without therapy.
Long-term pain is unique to everyone and thus requires a customized treatment plan.
Long-term pain is very elusive and requires the explicit input from you to guide the providers to where the pain is on that particular day. YOU must be trust!!!
Long-term pain take time and effort. You will have to chase it like the whack-a-mole game.

The ONLY therapy or “medicine” for Long-term pain is within a recipe: Wellness, minerals, exercise, sleep hygiene and —– movement of ALL your tissues.

The “medicine” recipe is applied in a 1 or 2 step form. The options should be chosen and customized by you and your wellness team.
The 1st step in the spectrum of therapies beginning with simple stretching, yoga, massage, Chiro adjustments, Active Tissue Release, Myofascial Unwinding, other hands-on manipulation options.

The 2nd step in the spectrum has to be done with a stainless steel needle; Acupuncture and all of the various types, Gunn-Intramuscular Stimulation, dry needling to finally hypodermic wet/dry needling and various other hypodermic injections.

Dear Doctor Ibsen,
Please accept my heartfelt thanks for taking patients like me who have incurable medical conditions that give you suicidal pain 24/7. Our very lives are in your hands and I just want to give you my heartfelt thanks.
There is something on this witch hunt are missing………..Some of us are real sick people that will Never get better and we have no other choice but to seek out doctors like you. Here is something my doctor had to say about it:
>
> Doctors who use “hyperalgesia” as an excuse to withhold opioids are, in my opinion, biased, and incompetent. Most of all they tolerate human suffering.
>
> I find that opioids may occasionally cause hyperalgesia but it is due to the hormone suppression caused be opioids. Simple hormone replacement, in my experience, almost always relieves hyperalgesia.
>
> Ignorance is based on the fact that chronic pain, per se, is a great physiologic risk in that it causes excess sympathetic discharge with an increase in blood pressure, heart rate, and overall cardiovascular risk. It raises cortisone which causes hyperlipidemia, elevated cholesterol and sugar, and osteoporosis. Also, it cases degeneration of brain and other nervous tissue. Intractable pain severe enough to put people to bed on most days sometimes causes pituitary-adrenal collapse and the patient dies in their sleep.
>
> You and your fellow arachnoiditis patients need to start expressing your views to all parties about the concept of “failure to find pain relief with standard treatments”! Failure of standard pain treatment is when the patient hasn’t found relief with non-pharmacologic measures like PT and acupuncture and the use of prescription pharmacologic agents including topicals, neuropathic agents (“Anti-seizure”), anti-inflammatories, antidepressants, muscle relaxants, and a daily morphine equivalence doses of 80-100 mg a day.
>
> All severe chronic pain patients need to lobby and advocate for doctors who, like me, only take patients who have failed standard pain treatment.
>
> Best wishes always,
>
> Forest Tennant
>
> Contact Information:
>
> Forest Tennant M.D., Dr. P.H.
> Veract Intractable Pain Clinic
> 336 1/2 S. Glendora Ave.
> West Covina, CA 91790-3043
> Clinic Ph: 626-919-0064
> Clinic Fax: 626-919-0065
> Office Ph: 626-919-7476
> Office Fax: 626-919-7497
>
Intractable Pain / Severe Chronic Pain Management

4 years ago

marty

This is what happens when good doctors try to help ones that are really in pain. I’m sure he has tried to do his best to signal out the drug seekers. Doctors have tried me on everything from morphine to fentanyl etc etc. I try them but they are not for me. I do take vicodin for back and hip problems that are serious and even though it just takes the edge off I would be lost without it. Some days I take 2 , other days I may have to take 6 but I never abuse them. It’s those people that take 3 at a time that makes it hard for the doctors and chronic pain patients. There is no reason for that. If one isn’t working 2 more won’t help. My biggest concern is the prescribing of then for Fibro. They have never helped my fibro and it makes me wonder why people bitch and moan and groan so bad when they aren’t prescribed them for fibro or the pharmacy won’t fill them. I can only assume that these are examples of the drug seekers. Anyway thank you for your help to those who are really in need. I am just sorry you are paying the price for being what a good doctor is supposed to be about.

4 years ago

Elizabeth Gardner

Dr Ibsen – we see so many people who are legally addicted to their meds crossing over to heroin and illegal use of drugs in South Florida. They get arrested and their life really spirals out of control and that is when myself and other criminal defense and family lawyers have to try and help them get out of the mire. Thank you for being so courageous to help. I would also like to suggest that you look into some natural substances that Dr. McCurdy of U of Miss has been researching to help addicts get off Rx opiates and deal with pain – mitragyna speciosa. It is legal, won’t kill anyone and won’t have any harm to their body and you can add it to your withdrawal regime for them. And, it is legal and doesn’t require Rx.